DCMedical News: Tuesday, November 12, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, November 12, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY TODAY IN HEALTH CARE
Congress Back in Session
The Senate and the House resumed work today. Update: Senate version of drug price legislation pushed by Administration (here), analysis from CQ here. Medicare-for-all now “Warrencare,” here. Budget and Appropriations for FY2020 (already two months in) face a cliff (“shutdown”) November 21, eight legislative (“working”) days away.
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Another Study Showing Improved Nurse Staffing Lowers Mortality in Hospitals
A British group (here) finds that “Lower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. These findings highlight the possible consequences of reduced nurse staffing and do not give support to policies that encourage the use of nursing assistants to compensate for shortages of RNs.” In an editorial (here) to accompany the article, pioneering researcher Jack Needleman writes that, for RNs, “If there is no top of the curve effect for nurse staffing, more will always be better. So, how do we define standards for minimally appropriate staffing levels? It is infeasible to have a nurse for every hospitalised patient. Yet, it is also arbitrary to set the existing mean staffing level as the standard if higher staffing levels improves major outcomes for patients,” but, for nursing assistants, “Is the U-shaped relationship of nursing assistant staffing observed in other studies?” And, for good measure, “Are these results observed for other important outcomes beyond mortality—for instance, fall-related injuries, pressure ulcers, healthcare-acquired infections, readmissions to hospital?”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
2020 Medicare Parts A & B Premiums and Deductibles
On November 8, 2019, the Centers for Medicare & Medicaid Services (CMS) released the 2020 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs. Publication will take place in tomorrow’s (November 13) Federal Register. Fact sheet here, early release FR announcement of the hospital inpatient deductible ($1,408) here, premiums and other deductibles here (Part B $144.60 per month, 25% of expected costs).
MedPAC Report From November 7-8
The Medicare Payment Advisory Commission meeting last week had staff presentations followed by Commission discussion on hospital and physician practice consolidation (here), increasing the supply of primary care physicians (here), the Medicare Advantage quality incentive program (here) and benchmarks in the MA system (here), all on Thursday, and on post-acute care spending (here) and low-income beneficiary utilization of the Part D drug benefit (here) on Friday.
The provider consolidation study was in response to a request from Congress in August 2018. The study found that “super concentrated” provider markets (HHI ≥ 5,000) have increased to now dominate 57% of all metropolitan areas. The staff believes that—despite the role of academic and tertiary centers in fomenting consolidation—payment for inpatient hospital services is not affected. However, payment for “provider-based” physician offices (those acquired by hospitals) has increased, along with commercial health insurance payments for both in- and outpatient services. Staff report (based on surveys from the Physician Advocacy Institute) that the share of physicians employed by hospitals increased from 26% in 2012 to 44% in 2018. During that period, Medicare saw a 17% drop in the volume of chemotherapy claims from physician offices, and a 53% increase in such claims in hospital outpatient departments (HOPDs, now including the hospital-acquired and re-labeled physician offices). Likewise, claims for echocardiography were down 5% from physician offices in this period, and up 34% in hospital outpatient departments, while “office” visits in HOPDs were up 37%.
The finding that hospitals with greater market share leads to higher prices was contested by “a study funded by the AHA [American Hospital Association] [which] challenged this finding but did not use actual price data,” in contrast to “other recent studies that used price data from claims [which] found consolidation was associated with higher prices.” While payments go up, however, costs do not—the staff finding that “the correlation between hospital market share and costs is positive, but not significant.” Most hospital consolidations are represented as lowering costs. The AMA has its own (annual) study of health insurer consolidation, 2019 edition here. The California Health Care Foundation checks in with its own study (“The Sky’s the Limit”) on provider consolidation, brief here, study here. Bloomberg sums up the current status of antitrust as “The Great Reawakening,” here.
READINGS AND REFERENCES
Whaaat??!
Economists among the least trusted professionals in the UK, reports a poll in the Financial Times, here.
Third Quarter Listing of Medicare and Medicaid program announcements, manuals, proposed rules, with staff telephone numbers, here.
Still . . . After All These Years
Enthoven, Fuchs and Shortell extol the virtues of managed competition in JAMA (here), cf. to Enthoven in Health Affairs in 1993 (here). Apologies to Paul Simon.
U.S. House of Representatives:
Members at https://www.house.gov/representatives
Committees and Members at https://www.house.gov/committees
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.
Committees and Members at https://www.senate.gov/committees
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
November publication dates: 13, 14, 15, 18, 19, 20, 21
December 3, 4, 5, 6, 9, 10, 11, 12
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.